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Health4AllHealth cash planPolicy Details
In return for the payment of the correct premiums, Insured Persons are eligible for benefits provided by this policy in accordance with theterms of the policy and the following schedules:Monthly icyholder only) 5.98 13.78 23.80 32.50 39.95Family(policyholder, Partner and dependent Children) 11.96 27.56 47.60 65.00 79.90(including Insurance Premium Tax)Maximum per Insured Person per Policy 100% 50 100 150 200 250Dental Trauma100% 200 400 600 800 1,000Optical100% 50 100 150 175 225Diagnostic consultation75% 100 175 250 400 650Therapiescombined maximum benefit75% 150 350 450 550 650Chiropody, homeopathy andreflexologycombined maximum benefit75% 50 75 125 175 225Per night- 10 20 30 40Per event- 10 20 30 40Lumpsum- 75 150 225 300Per Child- 75 150 225 300Hearing aids75% 100 150 300 500 750Health screening75% 50 75 125 175 250Access to care(adult benefit only)-- Hospital in-patientup to 30 nights per Policy YearHospital day-case surgeryup to 10 events per Policy YearRecuperationpayable automatically after a validhospital in-patient claim of at least10 consecutive nightsMaternity/paternity(adult benefit only)24 HOUR, 365 DAYS A YEAR TELEPHONE HELPLINE0800 107 6145Counselling - caring, practical help in areas related to stress, debt, crisis and addiction.Medical information on Social Services’ facilities, self-help groups and general medicaladvice.Legal advice on any private matter relating to UK law, including relationships, tax,employment and welfare benefits.24 HOUR, 7 DAYS A WEEK HELPLINEProviding access to a GP helpline 24 hours a day, 7 days a week.Also includes access to an online webcam consultation available Monday - Friday, 8.30am to6.30pm (excluding Bank Holidays).0345 303 7417 – GP helpline0345 127 7053 – Webcam consultationTelephone helpline(adult benefit only)-GP helpline and onlineconsultation service-Private prescription service-The private prescription service enables its doctors to issue private prescriptions andsend them directly to a registered pharmacy for dispatch to a patient.Discounted gym membership(adult benefit only)-Corporate membership rates at over 2,500 participating UK and Ireland gyms andfitness clubs.Where benefit is provided for Children the maximum amount is shared among all Children insured under the policy.
.Policy TermsDEFINITIONSIn this policy (except where the policy expressly provides otherwise), the following expressions have the meanings shown below:Child(ren)Any Child of Yours and/or Your Partner named in the policy schedule, who is below age 18 andpermanently residing with You. Foster Children are excluded.Dental TraumaMeans an unforeseen event caused directly by an accidental external impact which results in dentalinjuries.Insured Person(s)The person(s) insured under the policy as shown in the policy schedule.The total number of all insured Children will be classed as one Insured Person.PartnerThe one person named as such in the (family schemes) policy schedule, who is Your lawful spouse (orsome other person who cohabits with You) and who permanently resides with You.Policy YearIs the period of 12 calendar months from the start date of Your policy or from an anniversary of that date.The date of claim is deemed as:1 the date of admission for hospital in-patient or hospital day-case surgery for which benefit isclaimed;2 the date of the receipted account for charges made for dental, Dental Trauma, optical, diagnosticconsultation, therapies, reflexology, homeopathy, chiropody, health screening or hearing aids.3 the date of birth on the birth certificate(s) or the date of adoption of a Child qualifying formaternity/paternity benefit.We/Us/OurBHSF Limited.You/YourThe policyholder and, where applicable, any Partner or Children covered under Your policy.Reference to any statutory provisions shall include reference to any re-enactment or modification thereof.
PREMIUMS AND BENEFITSSubject to the remainder of this section, the policy will remain inforce for as long as premium payments are continued. Thepayment of benefits is conditional upon premiums being up to dateat the time of the incident which gives rise to the claim.Where Your employer is responsible for passing Us Yourpremiums, claim payments may be held if they are not receivedwithin a reasonable timeframe.All rights to benefit cease after the last day of the period coveredby the final premium payment.We reserve the right to decline or cancel this policy, or vary thepremiums/benefits on giving You at least four weeks prior notice atYour last known address for: A change in the applicable rate of Insurance PremiumTax (IPT). A change to Our expected claims experience. If We suspect any misrepresentation, concealment orfailure to comply with the terms and conditions as morespecifically set out in General Conditions 9 and 10. Fraud.If maternity/paternity benefit is to be withdrawn then 12 months’notice will be given.This policy will terminate when and if You cease employment withthe employer through which it has been arranged. However, within13 weeks of that happening You may apply to effect an alternativepolicy without any qualifying period applying.AGE LIMITSCover, on the basis set out above, is provided to You if You areage 16 or above, at the time of Our receipt of an application foreither a new policy or a change to the level of cover of an existingpolicy. The same age requirement applies to any Partner to beincluded. Children are covered until the date of their 18 th birthday.GENERAL CONDITIONS1. If You wish to make any change to the persons insured,then You should make an application to Us and, if thechanges are agreed, a new policy schedule will beissued.2. Premiums and claims are payable in sterling.3. This policy is bound by English law and shall be subjectto the jurisdiction of English Courts.4. All persons insured under this policy must be normallyresident in the United Kingdom.5. Worldwide emergency cover is included in the policy inrespect of emergency dental treatment or emergencypurchase of glasses which might be needed while aperson insured under this policy is abroad in accordancewith the respective policy terms.6. If You die, Your Partner, if insured under this policy, mayapply for a policy in their own name within 30 days ofYour death, without any qualifying period applying.7. A Child insured under this policy may, within 30 days ofattaining age 18, apply for an alternative policy in theirown name without any qualifying period applying.8. Transfer to a lower premium plan is not normallypermitted.9. Cover is subject to the conditions set out in theapplication form. Any material failure to complete thatform fully and truthfully entitles Us to terminate the policyforthwith and may invalidate any claims under the policy.10. The submission of a false or misrepresented claim mayresult in cancellation of the policy and/or legal actionagainst You. You are responsible for ensuring theaccuracy of claims made under this policy.11. Cooling off period – You have 14 days from the date Weissue Your policy documentation to review it. If You arenot satisfied with the policy, simply notify Us in writingwithin the 14 days and We will cancel Your policy.Provided a claim has not been paid We will refund anypremium collected.12. No sum payable under this policy shall carry interest.PRE-EXISTING CONDITIONS AND QUALIFYING PERIODSNo hospital in-patient claim will be paid during the first two yearsof a new or upgraded policy in respect of any health condition, orrelated health condition, which existed or was being investigatedbefore cover commenced. We may wish to verify medicalinformation to support a hospital related claim.Subject to this, and to the terms of this policy, Insured Personsbecome eligible for benefit after 13 weeks from the start date ofthe policy with the exception of maternity/paternity benefit which issubject to a 10 month qualifying period.The GP consultation service, discounted gym membership andtelephone helpline are available from the start date of the policy.No benefit will be paid in respect of treatment commenced duringthe qualifying periods, irrespective of the future duration of thatcourse of treatment.If an Insured Person is admitted to hospital as an immediatecasualty patient following an accident, the requirement for thecompletion of the qualifying period for hospital in-patient shall notapply.If You have upgraded Your policy to a higher level of cover, thenfor the following 13 weeks (10 months for maternity/paternity)benefits are restricted to that which would have been payableunder the previous level of cover; treatment commenced duringthis 13 week (10 months for maternity/paternity) period will beregarded as if the previous level of cover was still operative,irrespective of the future duration of that course of treatment.BenefitsDENTALBenefit is payable according to the benefit schedule up to themaximum benefit per Insured Person in each Policy Year fordental examination, dental treatment and dentures provided by aqualified dental practitioner who is on the Registers of the GeneralDental Council.Benefit is not payable:1. for any prescription charges2. for consumables such as toothbrushes, toothpaste, etc.3. for veneers or whitening procedures4. for premiums in respect of any form of dental insurance,dental care contract schemes or for any dentaladministration fees5. for mouth guards used for engaging in sporting activities.DENTAL TRAUMABenefit is payable according to the benefit schedule up to themaximum benefit per Insured Person in each Policy Year. Thebenefit may be claimed for dental examination and treatment coststo teeth and gums, provided by a qualified dental practitioner whois on the Registers of the General Dental Council, required as aresult of Dental Trauma.Benefit is not payable:1. for denture replacements2. for mouth guard or gum-shield replacements3. for any injury incurred as a result of the influence ofalcohol or drugs
4.5.6.7.for the cost of any routine dental treatment andexaminationsfor injuries incurred whilst participating in a contact sportwhere the appropriate mouth guard was not in placefor veneers or whitening proceduresfor damage to teeth caused entirely due to pre-existingdeterioration and not related to the injury claimed to havecaused, or aggravated the condition.OPTICALBenefit is payable according to the benefit schedule up to themaximum benefit per Insured Person in each Policy Year.The benefit may be claimed for:1 sight tests2 spectacles3 lenses4 contact lenses5 laser eye surgery.All of the above should be supplied or provided at the patient’scost for which the net payment is made directly to a qualifiedoptical practitioner registered with the General Optical Council.Laser eye surgery should be performed by a registered laser eyeclinic.Benefit is not payable:1. for frames only, cleaning solutions and sundries2. for cataract surgery3. for spectacles or lenses purchased under an optical carecontract scheme4. for sunglasses other than prescription sunglasses5. for protective eyewear and goggles/glasses used forengaging in sporting activities.DIAGNOSTIC CONSULTATIONBenefit is payable according to the benefit schedule up to themaximum benefit per Insured Person in each Policy Year inrespect of diagnostic consultations by a medical or surgicalspecialist holding consultant status in an NHS or registered privatehospital, described as such by the Care Quality Commission, onthe recommendation of the Insured Person’s General Practitioner.Within the maximum limits stated, tests used by the consultantwhich are required as part of the diagnostic process are covered.Benefit is not payable:1. for consultations in connection with pension, insurance,emigration or employment matters or for legal orindustrial actions2. for the cost of any treatment3. for the cost of room charges4. for health screening5. for consultations which are covered under ‘Therapies’,below6. for follow up consultations which do not form part of theinitial diagnostic process7. for scans or tests referred or requested by Your GP8. for pregnancy related scans performed in an antenatalclinic.THERAPIESBenefit is payable according to the benefit schedule up to thecombined maximum benefit per Insured Person in each PolicyYear, in respect of the following treatment:12Physiotherapy treatment provided by a qualifiedpractitioner who is on the Register of Physiotherapists ofthe Health and Care Professions Council.Osteopathic treatment provided by a qualifiedpractitioner registered with the General OsteopathicCouncil.34Chiropractic treatment provided by a qualifiedpractitioner registered with the General ChiropracticCouncil.Acupuncture treatment provided by a professionallyqualified and registered acupuncturist.Benefit is not payable:1. in respect of treatment by practitioners other than asdefined above2. for treatment which is not directly provided by thepractitioner on a one-to-one basis.CHIROPODY, HOMEOPATHY AND REFLEXOLOGYBenefit is payable according to the benefit schedule up to thecombined maximum benefit per Insured Person in each PolicyYear, in respect of the following treatment:123Chiropody treatment provided by a qualifiedchiropodist/podiatrist who is a member of a bodyregulated by the Health and Care Professions Council.Homeopathy treatment provided by a professionallyqualified and registered homeopath.Reflexology treatment provided by a professionallyqualified and registered reflexologist.Benefit is not payable:1. in respect of treatment by practitioners other than asdefined above2. for treatment which is not directly provided by thepractitioner on a one-to-one basis3. for homeopathic medicines or remedies.HOSPITAL IN-PATIENTHospital in-patient benefit may be claimed according to the benefitschedule on discharge from, or after 30 nights stay in, an NHS orregistered private hospital, described as such by the Care QualityCommission, per Policy Year, whichever is the sooner.A maximum of 30 nights benefit may be claimed in each PolicyYear per Insured Person. If the maximum benefit has been paidfor an Insured Person in a Policy Year, he/she must have beendischarged for a period exceeding one month before payment fora consecutive Policy Year commences.Benefit is restricted to a maximum of 20 nights per Policy Year ofthe 30 nights overall limitation for the following:1 treatment in hospitals outside the European Union2 geriatric or elderly rehabilitation, psychiatric treatment,rehabilitation, drug and substance abuse or alcoholism3 treatment resulting directly or indirectly from terroristaction.Benefit is not payable:1. in respect of hospital stays caused by a Pandemic, asdefined by the Department of Health, such as, but notlimited to, HIV/AIDS, Influenza, Avian Flu, SARS, ZikaVirus etc.2. in respect of cosmetic surgery, stays in a home for theelderly, health clinic, nursing home, hydrotherapy centreor similar institution or for residential stays in hospital fordomestic reasons3. in respect of any period of home leave during a period ofhospital in-patient treatment4. in respect of a pregnancy or any condition associatedwith a pregnancy which existed at the start date of thispolicy5. for hospital stays during which a birth occurs or whichimmediately follows a birth except
5.1. if in-patient treatment for the insured mothercontinues beyond six consecutive nights in whichcase hospital in-patient benefit for the mother maybe claimed from the seventh night onwards;5.2. if in-patient treatment for the insured Child continuesafter the date on which the mother is discharged,then hospital in-patient benefit for the Child may beclaimed from the birth date of the Child6. if not admitted to a ward.HOSPITAL DAY-CASE SURGERYBenefit is payable at the appropriate daily rate according to thebenefit schedule for up to ten occasions in each Policy Year perInsured Person following admission to an NHS or registeredprivate hospital, described as such by the Care QualityCommission for pre-arranged day-case surgery, includingendoscopic procedures.This surgery must be performed under sedation or general/localanaesthetic and must be carried out in the hospital where noovernight stay is included.Benefit is not payable:1. in association with a claim for hospital in-patient benefit2. in respect of cosmetic surgery, sterilisation, vasectomy,fertility treatment, pregnancy termination and outpatienttreatments3. for injections administered for the relief and/or control ofpain.RECUPERATIONBenefit is payable according to the benefit schedule once in eachPolicy Year per Insured Person. It is paid automatically with aneligible claim for hospital in-patient benefit for at least tenconsecutive nights. (No separate claim need be made.)MATERNITY/PATERNITYBenefit is payable according to the benefit schedule once in eachPolicy Year for the birth of Your Child or Children. Multiple birthsqualify for a multiple of the applicable payment. The amount isalso payable for Children under the age of three that You legallyadopt. The benefit according to the benefit schedule is onlyprovided to the policyholder, even where both parents are insuredunder this policy.A copy of the birth certificate or the legal adoption papers must beattached to the claim form.Benefit is not payable:In respect of any birth or adoption which occurs within 10 calendarmonths of the start date of this policy.HEARING AIDSBenefit is payable according to the benefit schedule up to themaximum benefit per Insured Person in each Policy Year for newhearing aids supplied by a registered hearing aid dispenser who ison the register of the Health and Care Professions Council.Benefit is not payable:1. for hearing aid contract schemes2. for replacement batteries3. for repairs.HEALTH SCREENINGBenefit is payable according to the benefit schedule up to themaximum benefit per Insured Person in each Policy Year forhealth screening performed in a hospital or health screeningcentre by medically qualified staff for WellWoman, WellMan,mammography, osteoporosis and heart disease screening.Benefit is not payable:1. for any screening other than as stated above (andspecifically not for tests carried out at a retail outlet,health club, fitness centre or the like)2. for screening or examinations in respect of pension,insurance, emigration, or employment matters or for legalor industrial actions.ACCESS TO CAREBenefit is the provision of telephonic information for the following:1 Treatment choices for major conditions.2 Advises of the most affordable price for You from privatehospitals.GP HELPLINE AND ONLINE CONSULTATION SERVICEContacting Your GP for medical advice, reassurance or guidance,especially outside surgery hours or during the working day, canoften prove inconvenient. And even after You’ve called thesurgery, You may face a long delay or have to take anappointment at an inconvenient time.To help provide reassurance, You are provided with access to a24 hour 7 days a week GP telephone consultation service.The service provides: Private GP telephone consultations 24 hours a day, 7days a week. The doctor can provide advice, diagnosis, reassuranceand a course of action as necessary. All advice is specificto You taking into account Your own personal medicalhistory. You can call as often as You need; consultations can beas long as appropriate. You can call about any health or medical concerns Youwould normally ask Your own GP but the service is notintended to replace Your own NHS GP. In an emergency,You should always contact Your NHS GP or theEmergency Services. A trained operator takes the call and consultations arescheduled with the doctor who calls You back at aconvenient time. There is plenty of time for an in-depthconsultation if required.PRIVATE PRESCRIPTION SERVICEAs part of the GP helpline and online consultation service, aprivate prescription service is also included.DISCOUNTED GYM MEMBERSHIPAccess to discounted and corporate membership rates at 2,500participating UK and Ireland gyms.Claims ProcedureFor access to care:If You wish to access this service please call 0870 160 1732 andremember to have Your policy number to hand.For the telephone helpline:For counselling or legal advice, please call 0800 107 6145 andremember to have Your policy number to hand.For the GP helpline, online consultation, and privateprescription service:To arrange Your private GP telephone consultation, please call0345 303 7417 and remember to have Your policy number tohand. If You need an prescription following Your consultation thiscan be arranged at the time of the call through Your privateprescription service. If You wish to access the webcamconsultation please call 0345 127 7053 with the above details tohand.
For the discounted gym membership:To find Your local participating club login to the My Gym Discountsportal at www.mygymdiscounts.co.uk and use company reference“BHSF”.For all other benefits the following applies:1. You can get a claim form from Our websitewww.bhsf.co.uk, or by phoning Our helpdesk on 0121629 1297. By registering for Our customer portal You canclaim online for certain benefits.2. The completed claim form with detailed original receipts(showing the date of the consultation, treatment orservice provided, and the name of the person for whomcharges were made directly by the practitioner or serviceprovider) must be received by Us within 13 weeks of:a) the date of discharge of the hospital in-patient, orb) the date of hospital day-case surgery, orc) the date on the original receipted account forconsultation and associated charges, ord) the date on the original receipted account for othercharges made; where such treatment continues overan extended period then claims need to be submittedperiodically, at intervals not exceeding 13 weeks, ore) the date of birth on the copy birth certificate(s) or thedate of adoption.3. Receipts are retained by Us and become Our property.4. Insured Persons will authorise the disclosure of anymedical or other information relevant to their claim whichis required by Us.5. Benefit may not be claimed from all insured sources formore than the total cost of consultation and associatedfees nor for more than the total cost of defined therapy,hearing aids, dental, Dental Trauma, chiropody,homeopathy, reflexology, health screening or opticaltreatment. In the event of dual insurance the benefit willbe restricted to the amount not recoverable from theother source or sources.6. Credit/Debit card receipts are not accepted.Benefit is only payable in respect of expense which is the directresponsibility of an Insured Person. Payment of benefit is alwaysmade direct to the policyholder.Before committing Yourself to treatment, if You have any questionabout the validity of a likely claim or are seeking clarification ofreflexology, acupuncture or homeopathy practitioners coveredunder this plan then please visit Our website at www.bhsf.co.uk ortelephone Our Helpdesk on 0121 629 1297.FRAUDYou must not act in a fraudulent manner. If You or anyone actingfor You:a) makes a claim under the policy knowing the claim to befalse or fraudulently exaggerated in any respect, orb) makes a statement in support of a claim knowing thestatement to be false in any respect, orc) submit a document in support of a claim knowing thedocument to be forged or false in any respect, ord) makes a claim in respect of any injury occasioned by awilful act or with the connivance of an Insured Person.Then:a)b)c)d)e)f)We shall not pay the claim.We shall not pay any other claim for that Insured Personwhich has been or will be made under the policy.We may at Our option declare the policy void.We shall be entitled to recover from You the amount ofany misrepresented claim already paid under the policy.We shall not make any return premium.We may inform the Police of the circumstances.CUSTOMER CAREWe continually strive to provide Our customers with outstandingvalue health cash plans and excellent service.If You have a comment about Your policy, a claim You havesubmitted or the service We have provided, please contact Ourtelephone helpline on 0121 629 1297.In the event of a complaint, You should write to BHSF Limited,Darnley Road, Birmingham, B16 8TE or telephone Us on 0121629 1297, quoting Your policy number. If You are not satisfied withthe way Your complaint is dealt with You may refer it to theFinancial Ombudsman Service, whose details will be provided inOur response to You.The Financial Ombudsman Service will only consider Yourcomplaint if You have first addressed the matter through Ourcomplaints process and received Our response.PROTECTING YOUR DATAWe will store Your information in accordance with General DataProtection Regulations. We will use Your information for riskassessment, research and statistical purposes, claims handlingand for the general administration of Your policy.At BHSF We are committed to protecting Your data andcompliance with data protection legislation.Our aim in processing Your data is to successfully deliver Ourservice to You with an appropriate level of data sharing whilstrecognising the need to protect Your fundamental rights to privacy.For further information please see Our full Privacy Statement byvisiting Our website www.bhsf.co.uk/privacynotice. This documentfully sets out how and why We are processing the information Wehave on You. It also explains Your rights to access, rectify, restrictor erase Your data.FINANCIAL SERVICES COMPENSATION SCHEME (FSCS)BHSF Limited is covered by the FSCS. Compensation from thatscheme may be payable if We are unable to meet Our obligations(e.g. if We go out of business or into liquidation or are unable totrade). Entitlement depends on the type of business and thecircumstances of the claim.Further information about the scheme is available on the FSCSwebsite www.fscs.org.ukBHSF Limited is authorised by the Prudential Regulation Authorityand regulated by the Financial Conduct Authority and PrudentialRegulation Authority.
BHSF Limited is authorised by the Prudential Regulation Authorityand regulated by the Financial Conduct Authority and PrudentialRegulation Authority.BHSF LimitedDarnley RoadBirmingham B16 8TETel: 0121 454 36010121 629 1297 (Helpdesk)Calls are recorded and may be monitored for training and securitypurposes.Signed for and on behalf of BHSF LimitedGeoff GuerinChief Operations OfficerBF 03/19
4. for premiums in respect of any form of dental insurance, dental care contract schemes or for any dental administration fees 5. for mouth guards used for engaging in sporting activities. DENTAL TRAUMA Benefit is payable according to the benefit schedule up to the maximum benefit per Insured Person in each Policy Year. The
